DOCSLIB.ORG

Management of Obstetric Fistula for Health Care Providers – On-The-Job Training

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Obstetric Fistula for Health Care Providers – On-The-Job Training Management of Obstetric Fistula for Health Care Providers – On-the-Job Training Reference Manual March 2014 Government of Nepal Ministry of Health and Population National Health Training Center Management of Obstetric Fistula for Health Care Providers – On-the-Job Training Reference Manual March 2014 Government of Nepal Ministry of Health and Population National Health Training Center PREFACE Management of Obstetric Fistula for Health Care Providers—On-the-Job Training iii ACKNOWLEDGMENTS iv Management of Obstetric Fistula for Health Care Providers—On-the-Job Training CONTRIBUTORS’ NAMES FOR DEVELOPMENT OF TRAINING PACKAGE 1. Dr. Ajay Agrawal, Associate Professor, B.P. Koirala Institute of Health Sciences 2. Dr. Alka Singh, Associate Professor, Patan Academy of Health Science 3. Dr. Aruna Karki, Head of OBGYN Department, Kathmandu Model Hospital 4. Dr. Bandana Sharma, Associate Professor, Nepal Society of Obstetrician and Gynecologists 5. Dr. Bhola Ram Shrestha, Medical Superintendent, Mid-Western Regional Hospital, Surkhet 6. Ms. Binita Rai, Staff Nurse, B.P. Koirala Institute of Health Sciences 7. Dr. Blami Dao, Director, Maternal and Newborn Health, Jhpiego/Baltimore 8. Ms. Chandra Rai, Country Director, Jhpiego/Nepal 9. Ms. Dhana Basnet, Pubic Health Nurse Officer, Family Health Division 10. Dr. Ganesh Dangal, Consultant, Kathmandu Model Hospital 11. Dr. Harshad Shangvi, Vice President, Innovations, and Medical Director, Jhpiego 12. Dr. Jeffery Michael Smith, Sr. Maternal Health Technical Advisor, MCHIP 13. Ms. Julia Bluestone, Sr. Technical Advisor, Global Learning Office, Jhpiego/Baltimore 14. Dr. Kiran Regmi, Director, Family Health Division 15. Dr. Kundu Yangzom, Sr. Consultant, NORVIC/B&B Hospital 16. Ms. Kusum B.C. Staff Nurse, Western Regional Hospital, Surkhet 17. Dr. Kusum Thapa, ANE, Regional Technical Advisor, Jhpiego 18. Dr. Khageshwor Gelal, Sr. Integrated Medical Officer, National Health Training Center 19. Dr. Madhu Tumbhamphe, Sr. Consultant, Paropakar Maternity and Women’s Hospital 20. Dr. Mohan Chandra Regmi, Associate Professor, B.P. Koirala Institute of Health Sciences 21. Ms. Nancy Kiplinger, Sr. Technical Advisor, Global Learning Office, Jhpiego/Baltimore 22. Ms. Neera Thakur, Reproductive Health Officer, United Nations Population Fund 23. Dr. Padam Raj Pant, Professor, Tribhuwan University and Teaching Hospital 24. Dr. Pushpa Chaudhary, President, Nepal Society of Obstetrician and Gynecologists 25. Dr. Ramila Devkota, Medical Officer, National Health Training Center 26. Dr. Rene Genadry, OB/GYN, Clinical Professor of Obstetrics and Gynecology - Urogynecology and Reconstructive Pelvic Surgery, Clinical Professor of Urology 27. Ms. Reeta Limbu, Staff Nurse, B.P. Koirala Institute of Health Sciences 28. Dr. Ronald H. Magarick, Vice President, Technical Leadership, Jhpiego/Baltimore 29. Dr. Sapana Amatya, Registrar, Paropakar Maternity and Women’s Hospital 30. Dr. Saroja Pande, Sr. Registrar, Paropakar Maternity and Women’s Hospital 31. Dr. Shilu Adhikari, RH Specialist, United Nations Population Fund 32. Dr. Shilu Aryal, Sr. Consultant, Family Health Division 33. Dr. Shirley Heywood, Gynecologist, INF 34. Dr. Tarun Pradhan, Assistant Professor, B.P. Koirala Institute of Health Sciences 35. Dr. Willy Shasha, Sr. RHFP/MNH Advisor, Technical Leadership Office, Family Planning and Reproductive Health, Jhpiego Management of Obstetric Fistula for Health Care Providers—On-the-Job Training v TABLE OF CONTENTS List of Abbreviations ........................................................................................................... ix Chapter I: Epidemiology of Female Genital Tract Fistula Including Obstetric Fistula and Prevention .................................................................................................................... I-1 Overview ........................................................................................................................... I-1 Definition of Obstetric Fistula ............................................................................................ I-1 Types of Fistula ................................................................................................................. I-1 Magnitude of Genital Fistula ............................................................................................. I-2 Anatomy of the Female Bony Pelvis ................................................................................. I-3 Pathophysiology of Female Genital Fistula ....................................................................... I-3 Etiology of Genital Fistula ................................................................................................. I-4 Prevention of Obstetric Fistula .......................................................................................... I-5 Strategies for Prevention of Obstetric Fistula .................................................................... I-8 Recommendations to Prevent Obstetric Fistula ................................................................ I-8 Key Points ......................................................................................................................... I-9 References ...................................................................................................................... I-10 Chapter II: Diagnosis, Classification, Prognostic Factors, and Outcomes .................. II-1 Overview of Patient Assessment ..................................................................................... II-1 Anatomic Defects ............................................................................................................. II-1 Renal System Impairment ................................................................................................ II-1 Neurologic Impairment ..................................................................................................... II-2 Menstrual Abnormalities and Infertility ............................................................................. II-2 Depression ....................................................................................................................... II-2 Rectovaginal Fistula ......................................................................................................... II-2 Symphyseal Separation and Osteitis Pubis ..................................................................... II-3 History and Clinical Examination...................................................................................... II-3 Clinical Examination ......................................................................................................... II-4 Genitourinary Dye Test .................................................................................................... II-5 Pre-operative Investigations ............................................................................................ II-5 Classification and Staging ................................................................................................ II-6 Outcome and Prognosis .................................................................................................. II-9 Grading of the Degree of Anticipated Difficulty of the Repair ......................................... II-10 Key Points ...................................................................................................................... II-10 References ..................................................................................................................... II-11 vi Management of Obstetric Fistula for Health Care Providers—On-the-Job Training Chapter III: Management of Obstetric Fistula ................................................................ III-1 Introduction ..................................................................................................................... III-1 Conservative Management of Obstetric Fistula .............................................................. III-1 Surgical Management of Fistula...................................................................................... III-2 Wound-Healing Optimization and Biologic Grafts for Genital Fistula Surgery ................ III-4 Standard Infection-Prevention Practices ......................................................................... III-4 Basic Surgical Techniques of Fistula Repair ................................................................. III-10 Principles of PostOperation Care .................................................................................. III-12 Special Considerations ................................................................................................. III-13 Key Points ..................................................................................................................... III-16 References .................................................................................................................... III-17 Chapter IV: Complications after Fistula Surgery and Their Management ................... IV-1 Overview of Complications ............................................................................................. IV-1 Complications of Obstructed Labor and Fistula Surgery ................................................. IV-1 Bladder Diary ................................................................................................................. IV-6 Pad Test ........................................................................................................................
Load more

Recommended publications
  • Dysmenorrhoea
    [ Color index: Important | Notes| Extra | Video Case ] ​ ​ ​ ​ ​ ​ ​ ​ Editing file link ​ Dysmenorrhoea Objectives: ➢ Define dysmenorrhea and distinguish primary from secondary dysmenorrhea ➢ • Describe the pathophysiology and identify the etiology ➢ • Discuss the steps in the evaluation and management options References : Hacker and moore, Kaplan 2018, 428 boklet ,433 , video case ​ Done by: Omar Alqahtani ​ Revised by: Khaled Al Jedia ​ DYSMENORRHEA Definition: dysmenorrhea is a painful menstruation it could be primary or secondary ​ ​ Primary dysmenorrhea Definition: Primary dysmenorrhea refers to recurrent, crampy lower abdominal pain, along ​ ​ with nausea, vomiting, and diarrhea, that occurs during menstruation in the absence of pelvic pathology. It is the most common gynecologic complaint among adolescent girls. ​ ​ Characteristic: ​ The onset of pain generally does not occur until ovulatory menstrual cycles are established. ​ ​ Maturation of the hypothalamic-pituitary-gonadal axis leading to ovulation occurs in half of the teenagers within 2 years post-menarche, and the majority of the remainder by 5 years post-menarche. (so mostly it’s occur 2-5 years after first menstrual period) ​ • The symptoms typically begin several hours prior to the onset of menstruation and continue ​ ​ for 1 to 3 days. ​ ​ • The severity of the disorder can be categorized by a grading system based on the degree of menstrual pain, the presence of systemic symptoms, and impact on daily activities Pathophysiology Symptoms appear to be caused by excess production of endometrial prostaglandin F2α ​ ​ resulting from the spiral arteriolar constriction and necrosis that follow progesterone withdrawal as the corpus luteum involutes. The prostaglandins cause dysrhythmic uterine contractions, hypercontractility, and increased uterine muscle tone, leading to uterine ischemia.
    [Show full text]
  • Evaluation of the Uterine Causes of Female Infertility by Ultrasound: A
    Evaluation of the Uterine Causes of Female Infertility by Ultrasound: A Literature Review Shohreh Irani (PhD)1, 2, Firoozeh Ahmadi (MD)3, Maryam Javam (BSc)1* 1 BSc of Midwifery, Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran 2 Assistant Professor, Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran 3 Graduated, Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran A R T I C L E I N F O A B S T R A C T Article type: Background & aim: Various uterine disorders lead to infertility in women of Review article reproductive ages. This study was performed to describe the common uterine causes of infertility and sonographic evaluation of these causes for midwives. Article History: Methods: This literature review was conducted on the manuscripts published at such Received: 07-Nov-2015 databases as Elsevier, PubMed, Google Scholar, and SID as well as the original text books Accepted: 31-Jan-2017 between 1985 and 2015. The search was performed using the following keywords: infertility, uterus, ultrasound scan, transvaginal sonography, endometrial polyp, fibroma, Key words: leiomyoma, endometrial hyperplasia, intrauterine adhesion, Asherman’s syndrome, uterine Female infertility synechiae, adenomyosis, congenital uterine anomalies, and congenital uterine Menstrual cycle malformations. Ultrasound Results: A total of approximately 180 publications were retrieved from the Uterus respective databases out of which 44 articles were more related to our topic and studied as suitable references.
    [Show full text]
  • (IJCRI) Abdominal Menstruation
    www.edoriumjournals.com CASE SERIES PEER REVIEWED | OPEN ACCESS Abdominal menstruation: A dilemma for the gynecologist Seema Singhal, Sunesh Kumar, Yamini Kansal, Deepika Gupta, Mohit Joshi ABSTRACT Introduction: Menstrual fistulae are rare. They have been reported after pelvic inflammatory disease, pelvic radiation therapy, trauma, pelvic surgery, endometriosis, tuberculosis, gossypiboma, Crohn’s disease, sepsis, migration of intrauterine contraceptive device and other pelvic pathologies. We report two rare cases of menstrual fistula. Case Series: Case 1: A 27- year-old nulliparous female presented with complaint of cyclical bleeding from the abdomen since three years. There was previous history of hypomenorrhea and cyclical abdominal pain since menarche. There is history of laparotomy five years back and laparoscopy four years back in view of pelvic mass. Soon after she began to have blood mixed discharge from scar site which coincided with her menstruation. She was diagnosed to have a vertical fusion defect with communicating left hypoplastic horn and non-communicating right horn on imaging. Laparotomy with excision of fistula and removal of right hematosalpinx was done. Case 2: 25-year-old female presented with history of lower segment caesarean section (LSCS) and burst abdomen, underwent laparotomy and loop ileostomy. Thereafter patient developed cyclical bleeding from scar site. Laparotomy with excision of fistulous tract and closure of uterine rent was done. Conclusion: Clinical suspicion and imaging help to clinch the diagnosis. There is no recommended treatment modality. Surgery is the mainstay of management. Complete excision of fistulous tract is mandatory for good long-term outcomes. International Journal of Case Reports and Images (IJCRI) International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.
    [Show full text]
  • Recurrent Hematometra with Endometriosis in an Adolescent Girl: a Case Report
    International Journal of Reproduction, Contraception, Obstetrics and Gynecology Garg R et al. Int J Reprod Contracept Obstet Gynecol. 2019 Nov;8(11):4567-4569 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20194895 Case Report Recurrent hematometra with endometriosis in an adolescent girl: a case report Sarita Agrawal, Rajshree Sahu*, Pushpawati Thakur, Vinita Singh, Pawan B. Chandramohan Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India Received: 18 August 2019 Revised: 19 September 2019 Accepted: 09 October 2019 *Correspondence: Dr. Rajshree Sahu, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Hematometra is a collection or retention of blood in the uterine cavity. This condition is most commonly associated with congenital uterine anomalies that result from abnormal formation, fusion or resorption of Mullerian ducts during fetal life or may be due to prior surgical procedures, causing an obstruction of the genitourinary outflow tract. We report an unusual case of hematometra with endometriosis secondary to cervical stenosis. This is a rare and important case report due to the complexity of diagnosis as cervical stenosis was not presented as primary amenorrhoea as its usual presentation. This case was successfully managed by Hysteroscopic cervical dilatation under USG guidance followed by transcervical insertion of a catheter to prevent recurrent stenosis.
    [Show full text]
  • Clinical Outcomes of Hysterectomy for Benign Diseases in the Female Genital Tract
    Original article eISSN 2384-0293 Yeungnam Univ J Med 2020;37(4):308-313 https://doi.org/10.12701/yujm.2020.00185 Clinical outcomes of hysterectomy for benign diseases in the female genital tract: 6 years’ experience in a single institute Hyo-Shin Kim1, Yu-Jin Koo2, Dae-Hyung Lee2 1Department of Obstetrics and Gynecology, Yeungnam University Hospital, Daegu, Korea 2Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea Received: March 17, 2020 Revised: April 7, 2020 Background: Hysterectomy is one of the major gynecologic surgeries. Historically, several surgical Accepted: April 14, 2020 procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam Corresponding author: University Hospital. Yu-Jin Koo Methods: We retrospectively reviewed patients who underwent a hysterectomy for benign dis- Department of Obstetrics and eases from 2013 to 2018. Data included the patients’ demographic characteristics, surgical indi- Gynecology, Yeungnam University cations, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu Results: A total of 809 patients were included. The three major indications for hysterectomy were 42415, Korea uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was Tel: +82-53-620-3433 total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During Fax: +82-53-654-0676 the study period, the rate of open hysterectomy was nearly constant (29.4%–38.1%). The mean E-mail: [email protected] operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 min- utes).
    [Show full text]
  • Experiences of Women with Obstetric Fistula in Nigeria: a Narrative Inquiry
    THE UNIVERSITY OF HULL Experiences of Women with Obstetric Fistula in Nigeria: A Narrative Inquiry A Thesis Submitted to the University of Hull in Fulfilment of the Award of Degree of Doctor of Philosophy in Health Studies By Hannah Mafo Degge MPH (2011) University of Leeds, UK April 2018 DEDICATION In loving memories of my beloved husband, Abraham Degge (who believed in me and set me on the path to doing a PhD) and my beloved son Boyesoko Degge (too wonderful a son to be forgotten) And to the brave women, who shared their stories- “A voice to make maternal healthcare accessible to all” ii ACKNOWLEDGEMENT The PhD journey has been a long and hard journey that would have been impossible to achieve without the kindness, support and encouragement of numerous people. First and foremost, I sincerely and deeply appreciate my supervisors, Prof Mark Hayter and Dr Mary Laurenson, for their thorough and relentless guidance, support and encouragement all through the study process. I acknowledge with deep gratitude Dr Moira Graham, Research Director, Faculty of Health Sciences for your ceaseless words of encouragement and support. I wish to also acknowledge the support of EVVF centre, BHUTH, and particularly the director, Dr Sunday Lengmang for the encouragement and sustained motivation to do this research. My parents Chief and Mrs. Andrew Aileku OFR, my brothers and sisters and their families, who stood solidly behind me in this journey. I sincerely appreciate your prayers, support and encouragement, that kept me moving on throughout the study period. My PhD colleagues who became like a family to me, too numerous to mention, I appreciate the support and encouragements of Sheena McRae, Love Onuorah, Yetunde Atayeiro, Franklin Onwukgha, and Peninah Agaba, challenging me to keep moving forward.
    [Show full text]
  • Page Mackup January-14.Qxd
    Bangladesh Journal of Medical Science Vol. 13 No. 01 January’14 Case report: Unilateral Functional Uterine Horn with Non Functioning Rudimentary Horn and Cervico-Vaginal Agenesis: Case Report Hakim S1, Ahmad A2, Jain M3, Anees A4. ABSTRACT: Developmental anomalies involving Mullerian ducts are one of the most fascinating disorders in Gynaecology. The incidence rates vary widely and have been described between 0.1-3.5% in the general population. We report a case of a fifteen year old girl who presented with pri- mary amenorrhea and lower abdomen pain, with history of instrumentation about two months back. She was found to have abdominal lump of sixteen weeks size uterus. On examination vagina was found to be represented as a small blind pouch measuring 2-3cms in length. A rec- tovaginal fistula (2x2 cms) was also observed. Ultrasonography of abdomen revealed bulky uterus (size 11.2x6 cm) with 150 millilitre of collection. A diagnosis of hematometra with iatro- genic fistula was made. Vaginal drainage of hematometra was done which was followed by laparotomy. Peroperatively she was found to have a left side unicornuate uterus with right side small rudimentary horn. Left fallopian tube and ovary showed dense adhesions and multiple endometriotic implants. Both cervix and vagina were absent. Total abdominal hysterectomy was done and rectovaginal fistula repaired. The present case is reported due to its rarity as it involved both mullerian agenesis with cervical and vaginal agenesis along with disorder of lat- eral fusion. This is an asymmetric type of mullerian duct development in which arrest has occurred in different stages of development on two sides.
    [Show full text]
  • Gynecological-DBQ
    INTERNAL VETERANS AFFAIRS USE GYNECOLOGICAL CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT - THE DEPARTMENT OF VETERANS AFFAIRS (VA) WILL NOT PAY OR REIMBURSE ANY EXPENSES OR COST INCURRED IN THE PROCESS OF COMPLETING AND/OR SUBMITTING THIS FORM. PLEASE READ THE PRIVACY ACT AND RESPONDENT BURDEN INFORMATION ON REVERSE BEFORE COMPLETING FORM. NAME OF PATIENT/VETERAN PATIENT/VETERAN'S SOCIAL SECURITY NUMBER NOTE TO PHYSICIAN - Your patient is applying to the U.S. Department of Veterans Affairs (VA) for disability benefits. VA will consider the information you provide on this questionnaire as part of their evaluation in processing the claim. VA reserves the right to confirm the authenticity of ALL DBQs completed by private health care providers. IS THIS DBQ BEING COMPLETED IN CONJUNCTION WITH A VA21-2507, C&P EXAMINATION REQUEST? YES NO If no, how was the examination completed (check all that apply)? In-person examination Records reviewed Other, please specify: Comments: ACCEPTABLE CLINICAL EVIDENCE (ACE) INDICATE METHOD USED TO OBTAIN MEDICAL INFORMATION TO COMPLETE THIS DOCUMENT: Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence.
    [Show full text]
  • Contemporary Issues in Obstetric Fistula
    CLINICAL OBSTETRICS AND GYNECOLOGY Volume 00, Number 00, 000–000 Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. Contemporary Issues in Obstetric Fistula L. LEWIS WALL, MD, DPHIL,*† ITENGRE OUEDRAOGO, MD,‡ and FEKADE AYENACHEW, MD§ *Department of Anthropology, College of Arts and Sciences; †Department of Obstetrics and Gynecology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri; ‡Association Renaissance Arena, Ouagadougou, Burkina Faso; Danja Fistula Center, Danja, Niger; and §International Fistula Alliance, Terrewode Women’s Community Hospital, Soroti, Uganda Abstract: We discuss a variety of contemporary issues connected: for example, a vesicovaginal relating to obstetric fistula. These include definitions of fistula is an abnormal opening between these injuries, the etiologic mechanisms by which fistulas occur, the role of specialist fistula centers in diagnosis the bladder and the vagina. and management, the classification of fistulas, and the Fistulas arise in different ways. A small assessment of surgical outcomes. We also review the number of fistulas are congenital, arising growing need for complex reconstructive surgical pro- from defects that occur during embryog- cedures, follow-up challenges, and the transition to a enesis.1 More commonly, however, fistu- fistula-free world in which other pathologies (such as 2,3 pelvic organ prolapse) will be of increasing importance. las are caused by trauma. Finally, we discuss the need to develop responsive The most common fistulas occurring in systems of maternal health care that treat women with females are genitourinary fistulas (vesico- competence, compassion, respect, and fairness. vaginal fistula, urethrovaginal fistula, Key words: obstetric fistula, vesicovaginal fistula, ’ ureterovaginal fistula, etc.) and genito- obstructed labor, women s rights enteric fistulas (especially rectovaginal fistula).
    [Show full text]
  • Obstetric Fistula Guiding Principles for Clinical Management and Programme Development
    Obstetric Fistula Guiding principles for clinical management and programme development Making Pregnancy Safer World Health Organization Contents Akcnowledgement iii Preface v Section I vii 1 Introduction 1 2 Principles for the development of a national or sub- national strategy for the protection and treatment 7 Annex A: Recommendationss on training from the Niamey meeting 22 Annex B: Recommendations on monitoring and evaluation of programmes from the Niamey meeting (2005) 25 Section II 27 3 Clinical and surgical principles for the management and repair of obstetric fi stula 29 Annex C: The classifi cation of obstetric fi stula 37 4 Principles of nursing care 39 Annex D: Patient card 45 5 Principles for pre and post operative physiotherapy 47 6 Principles for hte social reintegration and rehabilitation of women wh have had an obstetric fi stula repair 53 III Acknowledgments Editors: Gwyneth Lewis, Luc de Bernis, Fistula Manual Steering Committee established by the International Fistula working group: Andre De Clercq, Charlotte Gardiner, Ogbaselassie Gebream- lak, Jonathan Kashima, John Kelly, Ruth Kennedy, Barbara E. Kwast, Peju Olukoya, Doyin Oluwole, Naren Patel, Joseph Ruminjo, Petra Ten Hoope, We are grateful to the following people for their advice and help with specifi c chapters of this manual: Chapter 1: Glen Mola, Charles Vangeenderhuysen Chapter 2: Maggie Bangser, Adrian Brown, Yvonne Wettstein Chapter 3: Fistula Surgeons: Andrew Browning, Ludovic Falandry, John Kelly, Tom Raassen, Kees Waaldijk, Ann Ward, Charles-Henry Rochat, Baye Assane Diagne, Shershah Syed, Michael Breen, Lucien Djangnikpo, Brian Hancock, Abdulrasheed Yusuf, Ouattara Chapter 4: Ruth Kennedy Chapter 5: Lesley Cochrane Chapter 6: Maggie Bangser, Yvonne Wettstein Additional thanks are due to: France Donnay, Kate Ramsey, Claude Dumurgier, Rita Kabra, Zafarullah Gill.
    [Show full text]
  • Grading Pelvic Prolapse and Pelvic Floor Relaxation Using Dynamic Magnetic Resonance Imaging
    ADULT UROLOGY GRADING PELVIC PROLAPSE AND PELVIC FLOOR RELAXATION USING DYNAMIC MAGNETIC RESONANCE IMAGING CRAIG V. COMITER, SANDIP P. VASAVADA, ZORAN L. BARBARIC, ANGELO E. GOUSSE, AND SHLOMO RAZ ABSTRACT Objectives. With significant vaginal prolapse, it is often difficult to differentiate among cystocele, enterocele, and high rectocele by physical examination alone. Our group has previously demonstrated the utility of magnetic resonance imaging (MRI) for evaluating pelvic prolapse. We describe a simple objective grading system for quantifying pelvic floor relaxation and prolapse. Methods. One hundred sixty-four consecutive women presenting with pelvic pain (n ϭ 39) or organ prolapse (n ϭ 125) underwent dynamic MRI. The “H-line” (levator hiatus) measures the distance from the pubis to the posterior anal canal. The “M-line” (muscular pelvic floor relaxation) measures the descent of the levator plate from the pubococcygeal line. The “O” classification (organ prolapse) characterizes the degree of visceral prolapse beyond the H-line. Results. The image acquisition time was 2.5 minutes per study. Each study cost $540. In the pain group, the H-line averaged 5.2 Ϯ 1.1 cm versus 7.5 Ϯ 1.5 cm in the prolapse group (P Ͻ0.001). The M-line averaged 1.9 Ϯ 1.2 cm in the pain group versus 4.1 Ϯ 1.5 cm in the prolapse group (P Ͻ0.001). Incidental pelvic pathologic features were commonly noted, including uterine fibroids, ovarian cysts, hydroureter, urethral diverticula, and foreign body. Conclusions. The HMO classification provides a straightforward and reproducible method for staging and quantifying pelvic floor relaxation and visceral prolapse.
    [Show full text]
  • Prevalence & Factors Associated with Chronic Obstetric Morbidities In
    Indian J Med Res 142, October 2015, pp 479-488 DOI:10.4103/0971-5916.169219 Prevalence & factors associated with chronic obstetric morbidities in Nashik district, Maharashtra, India Sanjay Chauhan, Ragini Kulkarni & Dinesh Agarwal* Department of Operational Research, National Institute for Research in Reproductive Health (ICMR), Mumbai & *United Nations Population Fund, New Delhi, India Received February 20, 2014 Background & objectives: In India, community based data on chronic obstetric morbidities (COM) are scanty and largely derived from hospital records. The main aim of the study was to assess the community based prevalence and the factors associated with the defined COM - obstetric fistula, genital prolapse, chronic pelvic inflammatory disease (PID) and secondary infertility among women in Nashik district of Maharashtra State, India. Methods: The study was cross-sectional with self-reports followed by clinical and gynaecological examination. Six primary health centre areas in Nashik district were selected by systematic random sampling. Six months were spent on rapport development with the community following which household interviews were conducted among 1560 women and they were mobilized to attend health facility for clinical examination. Results: Of the 1560 women interviewed at household level, 1167 women volunteered to undergo clinical examination giving a response rate of 75 per cent. The prevalence of defined COM among 1167 women was genital prolapse (7.1%), chronic PID (2.5%), secondary infertility (1.7%) and fistula (0.08%). Advancing age, illiteracy, high parity, conduction of deliveries by traditional birth attendants (TBAs) and obesity were significantly associated with the occurrence of genital prolapse. History of at least one abortion was significantly associated with secondary infertility.
    [Show full text]